<header class="header">
	
	<h2 class="air_title" style="width: 100%;">激活会员卡</h2>
	<div class="air_cle"></div>
</header>
<div class="jh1_main">
	<ul class="jh1-list">
		<li>
			<div class="ne_pf_left" style="color:#ccc;">必填信息</div>

		</li>
		<li>

			<div class="ne_pf_left"><label class="la1">姓名</label>
				<input type="text" class="pla-input" name="username" />
			</div>
		</li>
		<li>
			<div class="ne_pf_left"><label class="la1">手机</label>
				<input type="text" class="pla-input" name="userphone" />
			</div>

		</li>
		<li>
			<div class="ne_pf_left"><label class="la1">验证码</label>
				<input type="text" class="pla-input" />
			</div>

			<a class="getVercode" 　href="#">获取验证码</a>
		</li>
		<li>
			<div class="ne_pf_left" style="color:#ccc;">选填信息</div>

		</li>
		<li>

			<div class="ne_pf_left">性别</div>
			<span class="pr_next01">
						<img src="images/jhb_03.jpg" alt="">
					</span>
		</li>
		<li>

			<div class="ne_pf_left"><label class="la1">生日</label>
				<input type="text" class="pla-input" name="userbirth" />
			</div>
		</li>
	</ul>
	<div class="readme">
		<input type="radio" class="rad-input checked" /> 我已阅读并同意
		<a class="card-btn">会员卡信息使用说明</a>
	</div>
	<a class="re_btn btn1" href="#">
		提交
	</a>
</div>